Hospital Practice News

AMA helps insurers improve claims payment accuracy

Thanks to AMA efforts, health insurers have cut in half the number of claims they pay inaccurately, saving $8 billion across the U.S. health care system.

That's according to the AMA's fifth annual National Health Insurer Report Card, the results of which were released in June during the Annual Meeting of the AMA House of Delegates. Measuring how major health insurance companies manage, process and pay medical claims, the report card has led to a number of improvements as the AMA has urged these insurers to better their performance.

Just last year, the number of claims insurers paid inaccurately was 19.3 percent, but that number dropped to 9.5 percent in 2012. This improvement saved physicians countless hours of work to reconcile errors and put billions of dollars previously wasted through insurers' administrative mistakes back into the health care system.

Since the AMA issued its first National Health Insurer Report Card in 2008, the private insurers it measures have shortened the time they take to respond to claims by 27 percent. Health Care Service Corporation and Humana had the fastest median response time of six days, while Aetna was the slowest with a median response time of 14 days.

Similarly, the rules the insurers use to edit claims have become 33 percent more transparent. When physicians know what these rules are, the time and cost to reconcile claims is reduced significantly.

But much improvement remains to be made. While better accuracy in claims payments saved time and money this year, physicians had to devote additional resources to prior authorization. The AMA found that the percentage of claims requiring prior authorization increased by 23 percent, adding $728 million in unnecessary administrative costs and countless hassles.

All but one of the private insurers also increased denials this year, reversing progress that had been made from 2008 to 2011. And insurers still need to work on their payment accuracy. The AMA estimates that an additional $7 billion could be saved if insurers consistently paid claims correctly.

The National Health Insurer Report Card is the cornerstone of the AMA's "Heal The Claims Process"™ campaign, which aims to reduce administrative waste through improving health care's billing and payment system. Physicians can access an array of resources to streamline the claims process in their own practices, including instructional webinars and toolkits.

Watch an archived webinar to learn more about this year's report card results.

Manual helps doctors with employment agreements

With more and more established physicians, as well as those completing training, becoming employees of hospitals, medical groups or affiliate organizations, it's important that they enhance their understanding and negotiating position as they navigate employment contracts and opportunities in these practice settings.

A manual from the AMA, the "Annotated Model Physician-Hospital Employment Agreement," can help. This resource addresses the specific needs of established physicians and those completing training who are preparing to negotiate an employment contract with a hospital or related entity.

AMA members can access the manual for free; nonmembers can purchase it through the AMA Bookstore. If you're not a member, join today.

View AMA-OMSS meeting materials

Highlights from this year's AMA Organized Medical Staff Section (OMSS) Annual Assembly Meeting are now posted online. Materials include the official meeting proceedings, a meeting summary and PowerPoint presentation summarizing the actions of the AMA-OMSS Assembly and the programs presented at the meeting. The meeting took place June 14–16 in Chicago prior to the Annual Meeting of the AMA House of Delegates.

This year's AMA-OMSS Interim Assembly Meeting will take place Nov. 8–10 in Honolulu. Watch AMA Wire and the AMA-OMSS Interim Assembly Meeting Web page for details.

Guide can help physicians draft bylaws for medical staff

Medical staffs looking to draft or amend bylaws can use the fifth edition of the AMA's "Physician's Guide to Medical Staff Organization Bylaws." This valuable reference manual contains bylaws language that supports self-governance, addresses Joint Commission standard MS.01.01.01 and offers guidance on emerging issues in health care that impact the medical staff. AMA members have free access to the guide. If you're not a member, join today.

CME activities are among education program webcasts

Learn about physician leadership, engaging members of the medical staff to improve quality and the future of the medical staff organization by viewing new webcasts from the AMA Organized Medical Staff Section. Physicians can claim continuing medical education (CME) credit for watching the webcasts. Titles include:

• "Doing the right thing for our patients: leading as a professional" (1.0 AMA PRA Category 1 Credit™)
• "Engaging members of the medical staff to measure and improve quality" (1.25 AMA PRA Category 1 Credits™)
• "Future of the medical staff: strategies for re-engineering governance and operations to advance clinical and strategic imperatives" (1.25 AMA PRA Category 1 Credits™)

AMA members can view these webcasts for free; nonmembers can watch them for $30 per credit hour. If you're not an AMA member, join today.

AMA offers expert guidance to employed physicians

Two new resources from the AMA aim to meet the unique needs of physicians who maintain employment or contractual relationships with hospitals, health systems and other entities.

The AMA's Physician Assistance Service answers physicians' questions and provides advice on physician-hospital issues such as employment and contracting, medical staff bylaws, credentialing, peer review, due process and medical staff self-governance. While the AMA cannot provide legal opinions or representation, it can provide assistance to physicians in matters pertaining to their relationships with hospitals, health systems, and other similar entities.

The AMA also has updated its physician employment Web page to highlight a wide range of AMA resources for physicians who are employed or considering employment.